Amended: A case against antidepressants

“This article has been found to have breached the Media Council Principle relating to comment and fact which requires that opinions must be based on accurate facts. See the Media Council decision at www.mediacouncil.org.nz." It has been amended to take account of the authors' acceptance of the word 'suicidality' instead of 'suicide' and to amend wording around MedSafe's views.

University of Auckland researchers make a case against the theory that mental illness is underpinned by chemical imbalances

In 1991, 12,712 adults in New Zealand received a disability payment due to mental illness. By 2016, this number had more than quadrupled to almost 55,000 with 17,302 having been on a disability benefit for more than 10 years.

While the numbers unable to work as a result of cardio-vascular disorders and diabetes have dropped, those who can't work because of mental disorders have continued to rise, with more people receiving a benefit for psychological and psychiatric conditions than those with cancer or musculo-skeletal disorders. According to the government, neuropsychiatric disorders are now the leading cause of health loss, accounting for more than double the death and disability arising from tobacco use.

In case anyone thought young high achievers were less prone to disabling psychiatric disorders, a 2014 study conducted by Middlemore Hospital and the University of Auckland found half of University of Auckland students had a sleep or mental disorder.

This massive increase in New Zealanders who are disabled as a result of mental illness is explained by psychiatry and the government as a result of brain abnormalities, specifically chemical imbalances, which are claimed to affect 47 percent of all New Zealanders and 51 percent of Māori in their lifetimes.

No explanation for the evolution (or devolution) which has caused our brains to malfunction to such an extent is offered, merely the suggestion that half of all humans have always suffered from debilitating psychiatric disease with the only change being our increased ability to detect it.

The problem with this argument is that we are in fact no better at detecting chemical imbalances underpinning depression or anxiety now than we were a thousand (or 10,000) years ago. Not because our technology is incapable of doing so, but the evidence produced by that technology shows they simply do not exist.

Eminent psychiatrist, Professor Ronald Pies of the State University of New York and Tufts School of Medicine, epitomises the embarrassment of academic psychiatry when faced with the chemical imbalance myth, attempting to distance psychiatry from the theory by stating:

I don't believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim [that patients have a chemical imbalance], except perhaps to mock it ... In truth, the 'chemical imbalance' notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.

Such a ‘preposterous claim’ is however made by the medical website Health Navigator which proudly displays its endorsement by the New Zealand government and the Royal College of GPs while advising that,

Antidepressants work by balancing the levels of neurotransmitter chemicals within your brain.

And that,

By restoring the chemical balance within your brain, antidepressants help to control both depression itself and many of the signs and symptoms of depression, including anxiety, agitation, exhaustion, insomnia and lack of concentration and appetite.

The New Zealand government’s health promotion agency, The Lowdown, promotes the theory as fact, telling teens:

Your body has chemicals in it that control your mood. Sometimes these chemicals get out of balance.

This ‘urban legend’ underpins not only the New Zealand government’s approach to public health education and mental health service provision but the approach of New Zealand doctors in encouraging patients to understand their distress as disease. It is the basis on which people accept prescriptions for antidepressants, drugs that 13.7 percent of all New Zealanders have been prescribed and whose prescription to children and teenagers has seen a 98 percent increase in the past 10 years.

Is it possible that there is a causal link between New Zealand’s high rate of antidepressant prescribing and our position as world leaders in youth suicide?

Psychiatry’s disease model explains all difficult human moods, emotions and behaviours as pathologies for which pills are the cure, allowing little room for political, social or cultural factors in explaining the causes and solutions for distress. Doctors promoting the theory justify their undermining of informed consent by claiming it reduces the stigma of a psychiatric diagnosis and therefore benefits patients. Unfortunately evidence shows this is another falsehood.

In fact, studies have shown that whose who believe their depression is caused by a chemical imbalance have a poorer prognosis than those offered other explanations. They suffer more stigma and self-blame, have a greater sense of helplessness and hopelessness in their ability to recover, and are less likely to have faith in, and engage in, talking therapies. Significantly when one considers the suicide and disability figures, they are less likely to take action to change lifestyle or environmental factors, less likely to engage in developing coping strategies, and are more likely to use medication. In a country reported by the OECD to have the highest rate of youth suicide in the developed world, along with one of the worst rates of child abuse, this last point is critical.

A 2016 analysis of the data produced in drug company antidepressant trials undertaken by Professor Peter Gøtzsche, director of the prestigious Nordic Cochrane Centre, found that antidepressant use doubles the risk of suicidality and violence [see Media Council discussion on this point] in young people. Pulitzer Prize nominated medical writer Robert Whitaker’s study of antipsychotic use found the drugs worsened long term outcomes and reduced life expectancy.

Is it possible that there is a causal link between New Zealand’s high rate of antidepressant prescribing and our position as world leaders in youth suicide? Could the fact that Professor Gøtzsche’s research, which found the drugs damage the brain and impair higher cognitive functions, account for the disability rates that have mirrored the rise in antidepressant prescribing? According to New Zealand drug regulator Medsafe, the doubling of suicidality risk is an 'already known' fact.

Embedded in our thinking about mental health and illness are notions of chemical imbalances, mental illness epidemics, and psychiatric ‘disease’: unscientific fallacies that are almost certain to escape scrutiny in the Government’s proposed review of the strengths and weaknesses of the current mental health system.

As a mother whose child was persuaded to take antidepressants by a doctor who told him that his sadness over a break-up with a girlfriend was actually a chemical imbalance which could be corrected by the drugs, who took his life 15 days after starting the drugs, and whose death the manufacturer of the drugs said was most likely to have been caused by their product, Maria Bradshaw cannot leave these notions unchallenged.

Consequently, in partnership with an Australian father whose son died in almost identical circumstances to Bradshaw's, she has arranged to bring together some of the world’s leading researchers on mental health outcomes, in a tour of New Zealand and Australia involving public lectures and meetings with politicians and key opinion leaders this month. The goal is to introduce an evidence based critique of biological psychiatry to the work of mental health reform in New Zealand and to raise awareness of the strengths of alternative paradigms of care in mental health, particularly those which have been shown to reduce rates of disability and suicide.

In addition to Professor Peter Gøtzsche and Robert Whitaker, the tour includes important presentations from University of Auckland sociologist Dr Bruce Cohen on the history of the mental health system, and University of Otago Professor, Roger Mulder, on the evidence that increasing access to and funding for mental health care has been associated with increased disability and suicide rates.

Information about the Mental Health in Crisis Lecture Tour is available here.

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